What is the treatment for Dengue?

Treatment of Dengue Fever

The cornerstone of dengue treatment is symptomatic management with careful fluid balance, as there is no specific antiviral therapy currently approved for dengue. 1

Diagnosis and Classification

• Dengue presents with fever, headache, retro-orbital pain, myalgia, arthralgia, and rash, with an incubation period of 4-8 days 2
• Diagnosis is confirmed by nucleic acid amplification tests (NAATs) on serum collected ≤7 days after symptom onset or IgM antibody testing for specimens collected >7 days after onset 3
• Classification ranges from mild dengue fever to severe forms including dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) 2

Treatment Algorithm

Step 1: Risk Stratification

• Assess for warning signs: persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding, rising hematocrit with falling platelet count 1
• Monitor daily complete blood count to track platelet counts and hematocrit levels 1

Step 2: Fluid Management

• For patients without shock:

  • Ensure adequate oral hydration (>2500ml daily) 2
  • Use oral rehydration solutions for moderate dehydration 2
  • Avoid routine use of bolus intravenous fluids in patients without shock 1

• For dengue shock syndrome:

  • Administer initial fluid bolus of 20 mL/kg with careful reassessment afterward 1
  • For severe shock, consider colloid solutions when available 1
  • For moderate shock, use crystalloid solutions as first-line therapy 1

Step 3: Symptom Management

• Use acetaminophen at standard doses for pain and fever relief 2
• Avoid aspirin and other non-steroidal anti-inflammatory drugs due to increased bleeding risk 1, 2

Step 4: Management of Complications

• For significant bleeding, blood transfusion may be necessary 1
• For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1

Monitoring Parameters

• Watch for clinical indicators of adequate tissue perfusion: normal capillary refill time, absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, return to baseline mental status, and adequate urine output 1
• Monitor for warning signs of progression to severe disease 1

Common Pitfalls to Avoid

• Administering excessive fluid boluses in patients without shock, which can lead to fluid overload and respiratory complications 1
• Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
• Using aspirin or NSAIDs, which can worsen bleeding tendencies 1
• Delaying fluid resuscitation in patients with dengue shock syndrome 1
• Inadequate monitoring during the critical phase of illness 1

Special Populations

• For pregnant women, acetaminophen remains the safest analgesic option 2
• In children, acetaminophen dosing should be carefully calculated based on weight 2
• For patients with possible exposure to both dengue and Zika virus, testing for both viruses is recommended 3

Prevention

• Dengue is transmitted by day-biting mosquitoes of the genus Aedes, particularly Aedes aegypti 2, 4
• Preventive measures include meticulous avoidance of mosquito bites 4
• Currently, no widely effective vaccine is available for all populations 4, 5

Prognosis

• Dengue fever takes a mild course in more than 90% of cases 4
• Severe dengue fever, including shock and/or mucosal hemorrhages, is rare and carries a mortality of 1-5% when properly managed 4